Childbirth Stage One: The Three Phases of Labor

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Childbirth progresses in three stages: labor, delivery of the baby and delivery of the placenta. Unless labor is cut short by a C-section, all women go through labor, the first stage of childbirth, which is in turn broken down into three phases: early, active and transitional.

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Phase 1: Early (latent) labor

The first of the three stages of labor, called the latent phase, is usually the longest, but thankfully it's also the least intense by far. Over a span of time from several hours to several weeks, often without noticeable or bothersome contractions, or over a period of no-doubt-about-it contractions, your cervix will dilate (open) to 3 centimeters and efface (thin out).

How to know you’re in early labor

You'll experience mild to moderate contractions that last 30 to 45 seconds, though they can be shorter, and might be regular or irregular. They may be spaced around 20 minutes apart and become progressively closer together, but not necessarily in a consistent pattern. You may not even notice them until the final two to six hours; if you're dilating gradually over a period of days or weeks, you probably won't feel them at all until labor starts in earnest. During early labor, you also might experience any of the following labor signs:

Rupture of the amniotic membranes (i.e. your water will break), though it's more likely to happen sometime during active labor

What you can do during early labor

You many feel excitement, relief, anticipation, uncertainty, anxiety or even fear. You might be relaxed and chatty or tense and apprehensive. All of these reactions are normal. It's important to try to relax as much as you can during the early phases of labor — you'll need to save your strength for later on.

If you’re feeling anxious: At nighttime, try to get some sleep (when your contractions become more insistent, you won't be able to). If you can’t, get up and try to distract yourself. Cook a few more dishes to add to your freezer stash, fold some baby clothes, do the rest of the laundry. During the day, go about your usual routine, or try taking a walk, which might even kick up the contractions a notch. Just don't stray too far from home, and don't go anywhere without a cellphone. Got nothing planned? Find something relaxing — watch TV, email friends, finish packing your hospital bag — to do to keep busy.

Alert your birth partner. You’ll definitely want to put your partner or whomever you plan to have with you at the hospital (including your doula, if you have one) on alert. That person probably doesn’t have to rush to your side just yet, since there’s not much to do this early on.

Keep an eye on contractions. But don't worry about obsessively timing them at this point, as it may just frustrate you. Instead, check periodically to see whether they're getting closer than 10 minutes apart. Most women and their nervous coaches will head to the hospital between the first two phases of labor — as the early phase ends and the active phase begins.

Pee often. Use the bathroom often — a full bladder can get in the way of labor.

Use relaxation techniques if they help, but don’t start any breathing exercises just yet or you may become exhausted long before you really need them.

When to call your practitioner

You and your practitioner should have discussed when to call (usually when you’re in more active labor). However you should definitely contact him or her right away if:

Your discharge becomes bright red or if you think you've released more than two tablespoons of it, since actual bleeding could indicate a problem with the placenta, like placenta previa or another condition that needs to be addressed as soon as possible.

Your membranes rupture and the amniotic fluid is greenish

You feel no fetal activity (though it may be hard to notice because you’re distracted by contractions — in which case have a snack or some juice, walk a bit, even jiggle your belly, then lie down, relax and try counting your kicks again).

Phase 2: Active Labor

The second stage, or active phase, of labor usually lasts from two to three-and-a-half hours (with a wide range of what's considered normal) as your cervix dilates to 7 centimeters. You'll usually be in the hospital or birthing center by this phase, or if you're delivering at home, your midwife should be with you by now.

How to know you’re in active labor

Your contractions will grow more concentrated and increasingly more intense — in other words, painful. As they become stronger and longer (typically lasting 40 to 60 seconds, with a distinct peak halfway through) and more frequent (coming every three to four minutes, though the pattern may not be regular), you can expect to feel all of the following (you won’t feel pain if you’ve had an epidural by this point):

Increasing pain and discomfort with contractions (you may not be able to talk through them now)

What the health care staff will do

Assuming everything is progressing normally and safely, the hospital staff will leave you alone, or stay out of your way but in your room, checking and monitoring you as needed, but also allowing you to work through your labor with your coach and other support people without interference. You can expect them to:

Possibly try to augment your labor if it’s progressing very slowly by the use of Picotin or by artificially rupturing the membranes (if they’re still intact). The new ACOG guidelines call for fewer or delayed labor interventions like augmenting or artificially rupturing membranes in low-risk pregnant women whose babies aren't showing signs of distress and who are progressing normally through labor unless absolutely necessary. They recommend trying various other pain management techniques like massage and changing positions before getting an epidural or other pain medication.

What you can do during active labor

With fewer breaks in the action, there’s less opportunity to rest between contractions. Emotionally, you may feel restless and find it more difficult to relax, and your concentration may grow more intense as you become absorbed in your labor efforts. Your confidence might waver along with your patience, or you may feel excited and encouraged. Whatever your feelings are, know that they’re normal — just get ready to start getting “active.” It’s all about your comfort now, so:

Ask for help. Don't hesitate to ask your coach for whatever you need to get and stay as comfortable as possible, whether it's a back rub, ice chips to suck on or a washcloth to cool your face. As much as your coach is going to want to help, he or she is going to have a hard time anticipating your needs — especially if this is your first baby together or it's your coach's first time doing this.

Start your breathing exercises. If you're planning on using them, start as soon as contractions become too strong to talk through. Didn’t plan ahead and practice? Ask the nurse or doula for some simple breathing suggestions. Remember to do whatever relaxes you and makes you feel more comfortable (if they aren’t working for you, don’t stick with them!).

Ask for an epidural. If you’d like medication for labor pain relief, now’s a good time to ask for it. An epidural can be given as soon as you feel you need it, though your practitioner may try to get you to do other things to ease your discomfort first, like getting into water before you start pushing, getting a massage, changing positions and having all the emotional support you need from those involved in delivering your baby.

Use relaxation techniques. Especially if you're having an unmedicated birth, relaxing between contractions will become increasingly difficult — but also increasingly important as your energy reserves are taxed.

Ask for a snack. If you’re hungry and have your practitioner’s OK, have a light snack (a popsicle, for example).

Stay on the move if you can. Walk around a bit (though you won’t be able to if you've had an epidural) or change positions.

Pee periodically. Continue to urinate regularly, too. You may not notice you need to because of the pelvic pressure, but a full bladder can keep you from making as much progress. If you’ve been given an epidural, you’ll already be hooked up to a catheter.

Phase 3: Transitional (Advanced) Labor

During the third stage, called transitional labor — the last, most intensive phase — your cervix will dilate from 7 to its final 10 centimeters. Fortunately it’s also the shortest, generally lasting from 15 minutes to an hour (though it can sometimes take up to three hours).

How to know you’re in transitional labor

Suddenly, the intensity of contractions picks up. They may become very strong and 60 to 90 seconds long, and with very intense peaks that last for most of the contraction. Some women, particularly those who have given birth before, may experience multiple peaks. Because they're spaced only about two or three minutes apart, it may seem as though you barely get to relax before the next contraction begins. During transition, unless you’re numbed by an epidural or other pain relief, you may feel:

Strong pressure in the lower back and/or perineum

Rectal pressure, with or without an urge to push

An increase in bloody show as capillaries in the cervix rupture

Feeling very warm and sweaty or chilled and shaky

Crampy legs that may tremble uncontrollably

Nausea and/or vomiting

Drowsiness between contractions

A tightening sensation in your throat or chest

Fatigue or exhaustion

What you can do during transitional labor

This last of the three stages of labor can be a physically demanding and draining time, but it can also be exhilarating. You may feel exhausted, impatient, disoriented or overwhelmed — or none of the above and feel only excitement and elation if you've had pain medication or have had a smooth labor so far. No matter what you're going through, hang in there — baby’s almost here! By the end of this phase, your cervix will be fully dilated and it’ll be time to begin pushing baby out. Try to focus on how far you’ve come.

Continue breathing techniques. If they’ve helped, of course. If you feel the urge to push before your cervix is fully dilated, ask your practitioner or doula for some guidance. Panting and/or blowing can help stop you from pushing if your practitioner says you're not ready yet — pushing before dilation is complete could cause your cervix to swell, which can delay delivery.

Speak up. If you don’t want anybody to touch you unnecessarily, or if your coach’s once comforting hands now irritate you, don’t hesitate to speak up.

Keep your eye on the prize. That bundle of joy will soon be in your arms!

When you’re a full 10 cm dilated, you’ll be moved to the delivery room, if you aren’t already there. Or if you’re in a birthing bed, the foot of the bed will simply be removed to prepare for delivery. Way to go! You've made it through the three stages of labor and it's time to push baby out!

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.

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